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Adjusting conventional FRAX estimates of fracture probability according to the recency of sentinel fractures

Adjusting conventional FRAX estimates of fracture probability according to the recency of sentinel fractures
Adjusting conventional FRAX estimates of fracture probability according to the recency of sentinel fractures
Summary: the risk of a recurrent fragility fracture is particularly high immediately following the fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the site of a recent fracture.

Introduction: the recency of prior fractures affects subsequent fracture risk. The aim of this study was to quantify the effect of a recent sentinel fracture, by site, on the 10-year probability of fracture determined with FRAX.

Methods: the study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Fracture probabilities were determined after a sentinel fracture (humeral, clinical vertebral, forearm and hip fracture) from the hazards of death and fracture. Fracture probabilities were computed on the one hand for sentinel fractures occurring within the previous 2 years and on the other hand, probabilities for a prior osteoporotic fracture irrespective of recency. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability for recent sentinel fractures.

Results: probability ratios to adjust 10-year FRAX probabilities of a major osteoporotic fracture for recent sentinel fractures were age dependent, decreasing with age in both men and women. Probability ratios varied according to the site of sentinel fracture with higher ratios for hip and vertebral fracture than for humerus or forearm fracture. Probability ratios to adjust 10-year FRAX probabilities of a hip fracture for recent sentinel fractures were also age dependent, decreasing with age in both men and women with the exception of forearm fractures.

Conclusion: the probability ratios provide adjustments to conventional FRAX estimates of fracture probability for recent sentinel fractures.
FRAX adjustment, Fracture probability, Imminent risk, Prior fracture, Risk assessment, Sentinel fracture
0937-941X
1817-1828
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Gudnason, Vilmundur
75cefe2e-c5f6-4d85-9a92-cd8c29dd6a94
Sigurdsson, Gunnar
53162212-0166-486a-8e94-4647c645d882
Siggeirsdottir, Kristin
bc469433-457c-420a-99c5-ef774c9ae4af
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Gudnason, Vilmundur
75cefe2e-c5f6-4d85-9a92-cd8c29dd6a94
Sigurdsson, Gunnar
53162212-0166-486a-8e94-4647c645d882
Siggeirsdottir, Kristin
bc469433-457c-420a-99c5-ef774c9ae4af
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78

Kanis, John A., Johansson, Helena, Harvey, Nicholas, Gudnason, Vilmundur, Sigurdsson, Gunnar, Siggeirsdottir, Kristin, Lorentzon, Mattias, Liu, Enwu, Vandenput, Liesbeth and McCloskey, Eugene V. (2020) Adjusting conventional FRAX estimates of fracture probability according to the recency of sentinel fractures. Osteoporosis International, 31 (10), 1817-1828. (doi:10.1007/s00198-020-05517-7).

Record type: Article

Abstract

Summary: the risk of a recurrent fragility fracture is particularly high immediately following the fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the site of a recent fracture.

Introduction: the recency of prior fractures affects subsequent fracture risk. The aim of this study was to quantify the effect of a recent sentinel fracture, by site, on the 10-year probability of fracture determined with FRAX.

Methods: the study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Fracture probabilities were determined after a sentinel fracture (humeral, clinical vertebral, forearm and hip fracture) from the hazards of death and fracture. Fracture probabilities were computed on the one hand for sentinel fractures occurring within the previous 2 years and on the other hand, probabilities for a prior osteoporotic fracture irrespective of recency. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability for recent sentinel fractures.

Results: probability ratios to adjust 10-year FRAX probabilities of a major osteoporotic fracture for recent sentinel fractures were age dependent, decreasing with age in both men and women. Probability ratios varied according to the site of sentinel fracture with higher ratios for hip and vertebral fracture than for humerus or forearm fracture. Probability ratios to adjust 10-year FRAX probabilities of a hip fracture for recent sentinel fractures were also age dependent, decreasing with age in both men and women with the exception of forearm fractures.

Conclusion: the probability ratios provide adjustments to conventional FRAX estimates of fracture probability for recent sentinel fractures.

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Publication Imminent risk v5 OSIN Rev - Accepted Manuscript
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Accepted/In Press date: 1 June 2020
e-pub ahead of print date: 1 July 2020
Keywords: FRAX adjustment, Fracture probability, Imminent risk, Prior fracture, Risk assessment, Sentinel fracture

Identifiers

Local EPrints ID: 442586
URI: http://eprints.soton.ac.uk/id/eprint/442586
ISSN: 0937-941X
PURE UUID: 9def0e24-f945-4e6a-a759-79d2ff871e1c
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 20 Jul 2020 16:31
Last modified: 22 Nov 2021 08:12

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Contributors

Author: John A. Kanis
Author: Helena Johansson
Author: Nicholas Harvey ORCID iD
Author: Vilmundur Gudnason
Author: Gunnar Sigurdsson
Author: Kristin Siggeirsdottir
Author: Mattias Lorentzon
Author: Enwu Liu
Author: Liesbeth Vandenput
Author: Eugene V. McCloskey

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